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Scarborough Hospital accused of being secretive about cuts, changes

The Scarborough Hospital and the arm’s length provincial agency that funds it are coming under fire for being secretive about decisions over cuts and changes to services.

“The lack of transparency is a major issue for the community,” charged Pat Sherman of the community group Friends of the Scarborough Hospital.

The hospital has come up with 200 ideas to find $19.6 million to balance its budget. Of those, 186 have been approved by the Central East Local Health Integration Network (LHIN), one of 14 such bodies across Ontario that plans and funds hospitals and other health services on behalf of the province.

While some of the measures to cut spending and hike revenue have been made public — including the elimination of almost 200 staff positions, the closing of two operating rooms and 20 surgical beds and a summer slowdown of medical care — neither the hospital nor the LHIN have disclosed the entire list.

Katie Cronin-Wood, spokeswoman for the LHIN, said that even though the body has given final approval to the cost-saving measures, it’s up to the hospital to make them public.

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“That’s their information, that’s their process,” she said.

But hospital spokesperson Toni Adey said that because staff affected by position eliminations are still being notified, “We are not prepared to share the line-by-line items of the initiatives at this time.”

However, when pressed further, and after the LHIN was informed a story was being prepared about not disclosing the changes, Adey said the Star would be given an “edited list” on Wednesday by which time affected staff would be notified.

Among the most frustrated by all the secrecy are the area’s two Liberal MPPs — Soo Wong (Scarborough Agincourt) and Bas Balkissoon (Scarborough Rouge River).

“These are organizations that get public dollars but are not being transparent,” Wong charged.

A former nurse and nursing teacher, Wong said she appreciates big changes are needed in the health system. But she is critical of how they are being carried out by the hospital’s board of directors and its former president, Dr. John Wright, who stepped down from the job just over a week ago.

“I have not had good confidence in them,” Wong said. “The board of directors at the Scarborough Hospital has not been respectful (and has not held) the senior management team accountable.”

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MPPs call for supervisor

Wong and Balkissoon have called on the province to appoint a supervisor to take over control of the hospital, but Health Minister Deb Matthews wants to give its new president a chance to sort things out.

“Something is wrong in the way this is being done. I have complained to the minister and the minister’s staff,” Balkissoon said.

Adey insisted the hospital has been forthcoming through an “extensive community engagement process” that included information meetings, web surveys, focus groups, presentations to community groups and information posted to its website.

“Our organization has been open and transparent about our funding realities and the changes we are making,” Adey said.

But Balkissoon is highly critical of the public consultation, noting that an information meeting in his constituency was poorly advertised and attended. In fact, the only people who showed up were from his and another politician’s office, he said.

“It left you with the impression that the administration was not interested in hearing from the public,” he said.

Balkissoon is also critical of the hospital board for going in-camera to vote on some of the cuts and changes at its March meeting, even after promising the vote would be public.

“This is something I would call total disrespect for the community,” he said.

Balkissoon said Scarborough residents would have a better appreciation of the difficult decisions that have to be made if there was more public discussion.

Minutes of board meetings of both the hospital and LHIN posted on their respective websites contain few specifics about the planned changes. In fact, there are no minutes posted for two teleconference meetings held by the hospital board on April 10 and 25, during which approval was given to implement the changes.

“The board never debated in front of the public so the public would have a better understanding why the board members are supportive of what’s going on,” Balkissoon said.

“You have a communications problem, you have top-down management rather than collaboration,” he charged.

Merger plan shocks MPP

Balkissoon said he was stunned recently to hear the LHIN had passed a motion, directing the Scarborough Hospital to start work on a merger with the Centenary site of the Rouge Valley Health System.

“That came out of the blue. When I read that I hit the roof,” he said. “We didn’t even know that Centenary was involved in this transformation. None of us were told.”

Of the 186 measures approved by the LHIN to balance the books, 172 are aimed at reducing expenses and 14 are aimed at increasing revenue.

Plans to move all birthing services to the hospital’s Birchmount site and move the majority of serious overnight surgeries to its general site were put on hold for further study after a public outcry.

The hospital has issued press releases, announcing cuts and changes are on the way but details are sparse. A press release issued earlier this month said some hospital services would be moved to community clinics, but did not specify which ones.

In an interview just over a week ago when asked whether outpatient clinics would be closing and services moved to the community, Wright said: “I don’t think there are any clinics moving out.”

But according to hospital insiders, there is talk of many clinics closing, including a fracture clinic, rheumatology clinic and a plastics clinic (for patients needing follow up after plastic surgery.)

Rumours also abound about the possible closure of a clinical day unit where, for example, patients go to get blood transfusions. There is talk of making changes to a sexual assault centre that would involve some kind of community partnership and there is even chatter about having fewer stretchers in the emergency room.

At a hospital board meeting on Tuesday, an operating plan for the 2013-14 fiscal year was presented in a PowerPoint presentation. Slides that were quickly flashed up on a screen revealed plans to close a diabetes education centre, reduce palliative care beds and move all outpatient rehabilitation to one hospital site. But there was no discussion about the plans.

Sherman accused the hospital of keeping residents and taxpayers who use the facility in the dark about changes that will affect them. He said he got little information when he attended a board meeting back in January and asked about plans to move services into the community.

“They danced around it. They didn’t answer it. They said, ‘Believe me, have faith, we are going to do it.’ I’m sorry I don’t,” he said.

Staff morale low

NDP Health critic France Gelinas said that what is going on in Scarborough is symptomatic of bigger problems facing Ontario’s health system.

“It’s no surprise that the community is concerned about the cuts and the secretive approach that the hospital and LHIN are taking. Ontarians know that the government has been making big promises on the benefits of moving services to the community, but this has too often led to less care and less transparency and oversight in our health-care system,” she charged.

Gelinas said promises to move services to the community don’t always materialize. And even when they do, Ontarians sometimes have to pay out of pocket for them, making them less accessible.

“Too many communities have lost access when services have moved to the community,” she said. “We need the government to stop encouraging hospitals to cut services without proper consultation and without a guarantee that they will be available in the community.”

Susan Brickell, who works as a registered nurse at the hospital and is a union representative with the Ontario Nurses Association, said staff morale is low because people don’t know what is going on.

“It’s a secret society,” Brickell said. “They are keeping things close to their chest. It’s a bad environment right now.”

Colleen Flood, a professor of health law at the University of Toronto, said moving health-care dollars from hospitals to the community where they can go further is a good idea.

Managing such a big reallocation of resources is no easy feat because people simply don’t like change, she said.

“I’m sympathetic because it is a tough thing they have to do,” Flood said.

Still, she said making decisions like that in camera is worrisome: “Moving away from transparency is something we should all be concerned about.” she said.

Health-care analyst Dr. Michael Rachlis said the only thing boards should discuss in-camera are personnel issues.

“For anything else, especially resource allocation, decisions should be made in the open,” particularly when it is public dollars that are involved, he said.

Rachlis said he appreciates the board’s sensitivity in wanting workers to be the first to hear of changes that might affect them.

“On the other hand, I think the value of openness and transparency should be paramount,” he said.

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